Binaural cue sensitivity in children and adults with combined electric and acoustic stimulation

项目摘要 采用微创手术技术和无创电极阵列的髋关节植入术， 成人和儿童人工耳蜗植入（CI）接受者的患病率不断增加， 电和双耳声刺激（EAS）。许多研究表明，成年EAS用户 在噪声和空间听力任务中， 与仅与对侧HA配对的CI相比。我们还证明了对耳间声的敏感性 时间差（ITD）和耳间水平差（ILD）提示与语后EAS益处相关。 成年人的听众。尽管发现处于活跃阶段，但对 儿科CI使用者的EAS结局、EAS拟合后的预期获益轨迹，以及 在所有人群中驱动EAS获益（或缺乏EAS获益）的潜在机制。之间存在脱节 所有CI接受者的EAS可用性和EAS使用以及EAS的当前听力学管理 候选人不是数据驱动的。考虑到双耳系统的长期成熟，这是有问题的， 事实上，我们不知道感音神经性听力损失和组合EAS可能会产生什么额外的影响， 对发展中的双耳系统有什么影响拟议的研究活动将描述 双耳发展使用行为和客观的反应，双耳之间的差异，在时间（阶段）和 水平，以及允许对临床干预的自然因素调查，EAS配件， 发展在临床试验的背景下，我们将比较急性和慢性EAS结果， 语音识别和空间听觉与双耳线索敏感性、线索加权和潜在的 解决ITD所需的神经同步。我们提出了一个单一的组分配为两个成年人 和儿科EAS用户，还将包括正常听力的时间和听力年龄匹配的听众， 听证会（NH）。EAS和NH听众的受试者内加速纵向设计将提供 深入了解儿童NH双耳系统的发展轨迹，并将提供基准 用于解释感音神经性听力损失的影响，耳蜗引起的可听度的不对称性， 植入和在所述轨迹上使用EAS。我们建议的研究活动将有助于缩小以下方面的差距： EAS技术在技术上的可行性以及耳科医生在临床上的应用， 研究双耳灵敏度和空间听觉能力发展的听力学家。所得到的数据 将包括第一次全面描述的行为和电生理措施的双耳 听力的成人和儿童都与NH和EAS，并将揭示有关我们的EAS临床信息 在器械装配以及听力学和耳科临床应用方面具有高潜力的人群 关于人工耳蜗植入的临床建议。

PROJECT SUMMARY Cochlear implantation with minimally traumatic surgical techniques and atraumatic electrode arrays has led to an increasing prevalence of adult and pediatric cochlear implant (CI) recipients with the potential for combined Electric and binaural Acoustic Stimulation (EAS). Many studies have demonstrated that adult EAS users consistently exhibit significant benefits for speech understanding in noise and spatial hearing tasks as compared to a CI paired only with a contralateral HA. We have also demonstrated that sensitivity to interaural time difference (ITD) and interaural level difference (ILD) cues is correlated with EAS benefit for postlingually deafened adult listeners. Despite this active phase of discovery, there is still a striking paucity of research on EAS outcomes in pediatric CI users, the expected trajectory of benefit following EAS fitting, as well as underlying mechanisms driving EAS benefit (or lack thereof) in all populations. There is a disconnect between EAS availability and EAS utilization in all CI recipients and current audiological management of EAS candidates is not data driven. This is problematic given the protracted maturation of the binaural system and the fact that we do not understand what additional effects sensorineural hearing loss and combined EAS may have on the developing binaural system. The proposed research activities will describe the time course of binaural development using behavioral and objective responses to interaural differences in timing (phase) and level as well as allow for a natural factor investigation of a clinical intervention, the EAS fitting, on said development. Within the context of a clinical trial, we will compare acute and chronic EAS outcomes for speech recognition and spatial hearing as related to binaural cue sensitivity, cue weighting, and underlying neural synchrony necessary for ITD resolution. We have proposed a single-group assignment for both adult and pediatric EAS users and will also include chronological- and hearing-age-matched listeners with normal hearing (NH). A within-subjects, accelerated longitudinal design for both EAS and NH listeners will provide insight into the developmental trajectory of the binaural system for children NH and will provide a benchmark for interpreting effects of sensorineural hearing loss, asymmetry in audibility resulting from cochlear implantation, and EAS use on said trajectory. Our proposed research activities will help close the gap between what is technologically possible with EAS technology and what is clinically implemented by otologists and audiologists investigating development of binaural sensitivity and spatial hearing abilities. The resultant data will comprise the first comprehensive description of behavioral and electrophysiologic measures of binaural hearing in adults and children both with NH and EAS and will uncover information about our EAS clinical populations holding high potential for clinical application in device fittings as well as audiologic and otologic clinical recommendations regarding cochlear implantation.